PROVIDENCE — The word came to Rhode Island Hospital at 12:13 p.m. Sunday. An MCI — mass casualty incident — had occurred at the circus, with at least six patients possibly in critical condition.

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By
Felice J. Freyer
Posted May. 5, 2014 @ 9:55 pm

PROVIDENCE — The word came to Rhode Island Hospital at 12:13 p.m. Sunday. An MCI — mass casualty incident — had occurred at the circus, with at least six patients possibly in critical condition.

Peter Ginaitt, director of emergency preparedness for Lifespan, Rhode Island Hospital’s parent company, was driving on Route 95 when his beeper went off. He was at the hospital within three minutes.

“All I heard was that the staging collapsed,” Ginaitt said. “We didn’t know if there were 9, 19 or 109.”

Rhode Island Hospital is home to the state’s only Level 1 trauma center and the region’s busiest emergency room. “This is what we’re here for. We’re ready to handle a large influx of patients like this,” said Dr. Michael Connolly, a trauma surgeon who was checking on his intensive-care patients when the call went out for help. He hurried to the emergency room immediately.

At least 10 trauma surgeons were already in the emergency department when Ginaitt arrived, along with a slew of nurses, respiratory therapists, pharmacists and staff from the diagnostic imaging department.

Patients in the trauma area were assessed and relocated to appropriate places elsewhere in the emergency department, to make room for the injured from the circus. The trauma area has six rooms, each fully equipped for two people. The operating rooms were prepared and staffed.

“Within, literally, 10 minutes we had the staff capacity to run five to seven ORs,” said Dr. Arthur A. Bert, the hospital’s chief of anesthesia. “Normally, we would be only running two on a regular Sunday.”

Bert lives five minutes from the hospital and came from home to help set up. He was joined by more than 40 people — surgeons, nurses, technologists and others — who, like him, came in to work on what would have been a day off.

By about 12:25, the patients started arriving — eight women and one man. All were conscious, but they had multiple, serious injuries. One patient was rushed immediately into surgery to stop life-threatening internal bleeding, Bert said. Others had broken and fractured bones, including bones breaking through the skin, an injury with a high risk of infection. Many had serious spinal fractures because they fell about 30 feet and landed on their legs, transmitting force up into the spine, he said.

Given the size of Rhode Island Hospital’s emergency department, it’s not all that unusual to have nine people show up at once, just by chance. And the circus performers were hardly the only people needing emergency care on Sunday. Someone injured in a head-on collision in Tiverton was arriving by helicopter around the same time. That afternoon, the hospital also handled an emergency transfer from another hospital and an emergency open-heart surgery.

But what distinguished this event from any other incident since the Station fire was that so many people needed surgery on the same day, Connolly said.

Often, different types of surgical specialists worked simultaneously on the same patient, so no one was under anesthesia longer than necessary, Bert said.

But the surgeons weren’t the only essential workers, Bert stressed. “We had two x-ray techs who worked 12, 14 hours. We needed x-rays back and forth. These two young men worked like dogs all day, never complained.” The last surgery was completed after midnight.

Bert said that the performers benefited from being physically fit, flexible and petite. “They’re the equivalent of world-class athletes,” he said.

One patient was released on Sunday. Eight remained hospitalized Monday; all are expected to survive.

“When I walked out after 16 hours,” said Bert, “I wasn’t exhausted. It wasn’t fatigue that overcame me. It was a lot of pride to be part of this great institution.”